[Analysis of Patients Discharged from a Palliative Care Unit].

For terminal-phase cancer patients, being discharged from a palliative care unit(PCU)is often challenging. To explore this reason, we compared patients who went home alive from the PCU with patients who died in the same unit. Among the survival cases, the average duration from their diagnosis to admission into the PCU was longer. Their slow progressions might allow them to leave the PCU. Patients with head and neck cancer were more often among those who died in the PCU, and the ratio of patient with endometrial cancer was higher in the survival cases. These ratios were relevant to the duration before their admission and variety of their symptoms.

[A Case of Subphrenic Lymph Node Metastasis from Gastric Cancer in Which FDG-PET/CT Was Useful for Diagnosis].

A 70-year-old man was admitted for lymph node metastasis detected by FDG-PET/CT showing a mass 10mm in diameter. He had a history of a distal gastrectomy for advanced gastric cancer and was administered postoperative adjuvant chemotherapy consisting of 2 courses of TS-1 with CDDP and TS-1 only for 1 year. Lymph node recurrence was diagnosed and resected 4 years after the initial surgery. Histological examination revealed lymph node metastasis of the gastric cancer. He was administered adjuvant chemotherapy using TS-1 and has been followed-up without recurrences for 17 months after the second operation. We reported a case in which FDG-PET/CT was potentially beneficial for the diagnosis of the postoperative small lymph node metastasis.

[A Case Report of Neuroendocrine Carcinoma in the Gall Bladder Showing Recurrence Shortly after Surgery].

A55 -year-old woman with a 10×8mm protuberant gallbladder lesion visited our hospital. To determine possible malignancy, she underwent laparoscopic excision biopsy of the gallbladder, and pathological findings revealed an endocrine carcinoma in the gallbladder. Surgery involved extrahepatic bile duct resection, gallbladder bed resection, and hepatic portal lymph node resection. Recurrence in the peritoneal lymph node was observed in the early postoperative period. Chemotherapy was initiated with cisplatin and irinotecan, and continues 18 months post-operatively. Neuroendocrine carcinoma of the gallbladder is rare and is known to have a poor prognosis, with few confirmed treatments reported for this disease due to its rarity. Therefore, we report this case along with a review of the literature.

[Surgically Managed Flail Chest Caused by Resuscitation].

A 84-year-old man who had experienced cardiac arrest in the ambulance was brought to the emergency room. He had been followed at outpatient after surgery for colon cancer and known to be suffered from mild renal impairment. The cardio pulmonary arrest was likely to be caused by acute exacerbation of that. He was resuscitated and immediately recovered without severe hypoxic encephalopathy or deterioration of renal function. However, the flail chest by manual cardiac compression sustained. It urged him to be managed under the ventilator and he seemed difficult to leave from that within a couple of weeks. So we decided to perform surgery. The course after surgery was favorable.

New strategy for the antifibrotic therapy with oral administration of FR260330 (a selective inducible nitric oxide synthase inhibitor) in rat experimental liver cirrhosis.

Inducible nitric oxide synthase (iNOS) activity is significantly elevated in viral hepatitis, alcoholic cirrhosis, and cholestasis. However, there are few reports on the relationship between iNOS and cirrhosis. Here, we investigated the effects of a new iNOS inhibitor that has been developed for oral administration in an experimental rat liver cirrhosis model. A cirrhotic rat model was developed by long-term administration of thioacetamide injections. FR260330 is a new, rationally designed, selective iNOS inhibitor that can be administered orally. After 12 weeks of treatment with FR260330, the rats showed inhibition of progressions of cirrhosis, ascites, and splenomegaly as well as a significant reduction in the proportions of connective tissue in the liver. The expression of nitrotyrosine, which indicates the existence of peroxynitrite and nuclear factor-kappaB activation, was remarkably decreased in the FR260330 treatment group. In addition, immunohistochemical and Western blot analyses showed that the expression of transforming growth factor-beta1 was remarkably decreased in this group. The present study demonstrates that FR260330 reduces liver fibrosis by the inhibition of transforming growth factor-beta1 and retards the development of cirrhosis. This oral iNOS inhibitor will be a new strategy for the treatment of cirrhosis.